Submitted by Stephen Mechanick, MD, Chair, Department of Psychiatry
I often “prescribe” exercise as a treatment for depression. Evidence that exercise is an effective treatment has been around since at least the late 1990’s. Studies indicate that exercise can augment traditional treatments for depression, and can increase the speed of recovery from depression. In addition, assuming the patient is in good health and exercises reasonably (e.g., 45 minutes to an hour three times a week), physical activity does not have the side effects of medications or the risks of drug-drug interactions. With exercise, a patient can be more actively engaged in treatment, and he or she can experience feelings of success (a feeling that is often depleted by the illness of depression) for whatever is accomplished.
Meta-analyses of studies concerning the effects of exercise on depression have shown modest benefits both for treatment of prevention and for prevention of recurrence of depression. A recent article in The Atlantic discussed the benefits of exercise, along with theories about how exercise “treats” depression (e.g., increased norepinephrine and/or endorphin release).
A more recent article in the New York Times cited a study that was published last month in Cell. In that study, researchers found that exercise raises levels of the enzyme PGC-1alpha1 in mice, which in turn increases metabolism of kynurenine and protects from stress-induced depression. While understanding of this pathway could lead to other treatments for depression, it also supports the use of a natural treatment – exercise – for treatment of depression.
Of course, not all patients are interested in exercise, or have sufficient motivation to persist with an exercise regimen. Symptoms of depression include decreased energy, decreased motivation, and insomnia, all of which can make exercising more daunting.
We certainly don’t want to make patients feel worse for “failing” their exercise treatment program. Instead, it is useful to discuss exercise as one of the available modalities for treatment of depression, and to see whether the patient is interested in trying it. If the patient chooses to try exercise, we can applaud any success that the patient may have, and express sympathy and understanding if the patient is not able to persist. Exercise can be combined with other treatments, such as psychotherapy and medication. For moderate to severe depressions, antidepressant medication may be necessary at the beginning of treatment, and exercise may be added to support treatment.
 Cooney, C. et al., “Exercise for Depression,” JAMA. 2014;311(23):2432-2433; Rimer, J. “Exercise for Depression,” 11 JUL 2012 | DOI: 10.1002/14651858.CD004366.pub5.
 Khazan, O., “For Depression, Prescribing Exercise Before Medication,” The Atlantic, March 24, 2014.
 Reynolds, G., “How Exercise May Protect Against Depression,” The New York Times, October 1, 2014.
 Ruas, J., et al, “Skeletal Muscle PCG-1alpha1 Modulates Kynurenine Metabolism and Mediates Resilience to Stress-Induced Depression,” Cell, Volume 159, Issue 1, Sept. 2014, p.33-45.